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©2013 UpToDate ® Print Email Approach to the patient with suspected heparin induced thrombocytopenia HIT should be suspected when there is thrombocytopenia, thrombosis with thrombocytopenia, a platelet count that has fallen by ≥50 percent, or necrotic skin lesions at injection sites in a patient started on heparin within the preceding 5 to 10 days. The diagnosis is initially made on clinical grounds, because assays with the highest sensitivity and specificity may not be readily available and have a slow turnaround time. HIT: heparin-induced thrombocytopenia; HIPA: heparin-induced platelet aggregation assay; Heparin-PF4 Ab: heparin-platelet factor 4 antibody. * Observation should be chosen only if patient is at high risk for bleeding. Otherwise treatment (anticoagulation with the agents listed) is preferred until the platelet count has returned to normal, at which time treatment with a vitamin K antagonist can be given (see text for details).